The Effect of Intravenous Infusion of Propofol or Aminophylline on Incidence and Severity of Post-dural Puncture Headache in Elective Cesarean Section

Abstract

Background: Post-dural puncture headache (PDPH) is caused by the persistent leak of cerebrospinal fluid (CSF) from the subarachnoid space. This leakage causes a decrease in the CSF volume and pressure leading to loss of the cushioning effect normally maintained by the intracranial fluid. This results in traction on the intracranial pain-sensitive structures, causing headache. The aim of the present study was to find ways to reduce the incidence and severity of PDPH in parturients undergoing spinal anesthesia for elective cesarean section. Patients and methods: This was a randomized controlled trial study conducted at Zagazig University Hospitals during the period from February to August 2020. It included 200 parturients, planned for elective caesarean section under spinal anesthesia. All parturients were kept nil orally (8 hrs for fatty meals, 6 hrs for light meals and 2 hrs for clear fluids) before the operation. Ranitidine 50 mg I.M was given to all parturients 90 minutes before the operation. Results: The severity, duration of headache was significantly lower in the propofol group compared with the control and aminophylline groups. There was no significant difference between aminophylline and control groups. Conclusion:We can conclude that propofol reduced the severity, the duration and the associated symptoms of post-dural puncture headache compared to aminophylline in parturients undergoing spinal anesthesia for elective cesarean section.

Efficacy of pharmacological therapies for preventing post-dural puncture headaches in obstetric patients: a Bayesian network meta-analysis of randomized controlled trials

“…Twelve studies reported side effects during the perioperative period [ 20 , 27 – 30 , 32 – 35 , 39 , 40 , 42 ]. All twelve studies reported PONV [ 20 , 27 – 30 , 32 – 35 , 39 , 40 , 42 ].…”

“…Twelve studies reported side effects during the perioperative period [ 20 , 27 – 30 , 32 – 35 , 39 , 40 , 42 ]. All twelve studies reported PONV [ 20 , 27 – 30 , 32 – 35 , 39 , 40 , 42 ]. Meanwhile, the results demonstrated that PPF and OND had lower incidence of PONV compared to the placebo group (OR = 0.07, 95% CI: 0.01 to 0.30; and OR = 0.12, 95% CI: 0.02 to 0.63, Fig.…”

“…Soleimanpour et al performed an RCT and proved that intravenous PPF was a more effective and safer treatment than DXM for patients presenting with migraine headaches [ 52 ]. Later, Golfam [ 33 ], Refky [ 20 ], and their colleagues attempted to use PPF for preventing PDPH in obstetric patients. The mechanism of PPF in PDPH prevention still needs further study.…”

Post-dural puncture headache prevention and treatment with aminophylline or theophylline: a systematic review and meta-analysis

“…1 and 2 show the risk of bias in individual trials and the risk of each bias among all trials, respectively. Eight studies described the method of assigning participants to the intervention and control groups by random sequence generation [10,11,19,[23][24][25][26][27], whereas the others did not provide a complete explanation. Allocation concealment was reported in only three studies [1,28,29] and four trials were not blinded [26,27,[29][30][31].…”

“…Eight studies described the method of assigning participants to the intervention and control groups by random sequence generation [10,11,19,[23][24][25][26][27], whereas the others did not provide a complete explanation. Allocation concealment was reported in only three studies [1,28,29] and four trials were not blinded [26,27,[29][30][31]. No high risk of attrition bias was detected in the included studies.…”